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Chen WJ, Du H, Hu HF, Lian JQ, Jiang H, Li J, Chen YP, Zhang Y, Wang PZ. Levels of peripheral blood routine, biochemical and coagulation parameters in patients with hemorrhagic fever with renal syndrome and their relationship with prognosis: an observational cohort study. BMC Infect Dis 2024; 24:75. [PMID: 38212688 PMCID: PMC10782698 DOI: 10.1186/s12879-023-08777-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/01/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Hantaan virus (HTNV), Seoul virus (SEOV) and Puumala virus (PUUV) are major serotypes of the Hantavirus, which can cause hemorrhagic fever with renal syndrome (HFRS). The pathophysiology of HFRS in humans is complex and the determinants associated with mortality, especially the coagulation and fibrinolysis disorders, are still not been fully elucidated. Severe patients usually manifest multiple complications except for acute kidney injury (AKI). The aim of this study was to observe the levels of peripheral blood routine, biochemical and coagulation parameters during the early stage, so as to find independent risk factors closely related to the prognosis, which may provide theoretical basis for targeted treatment and evaluation. METHODS A total of 395 HFRS patients from December 2015 to December 2018 were retrospectively enrolled. According to prognosis, they were divided into a survival group (n = 368) and a death group (n = 27). The peripheral blood routine, biochemical and coagulation parameters were compared between the two groups on admission. The relationship between the parameters mentioned above and prognosis was analyzed, and the dynamic changes of the coagulation and fibrinolysis parameters during the first week after admission were further observed. RESULTS In addition to AKI, liver injury was also common among the enrolled patients. Patients in the death group manifested higher levels of white blood cell counts (WBC) on admission. 27.30% (107/392) of the patients enrolled presented with disseminated intravascular coagulation (DIC) on admission and DIC is more common in the death group; The death patients manifested longer prothrombin time (PT) and activated partial thromboplastin time (APTT), higher D-dimer and fibrinogen degradation product (FDP), and lower levels of platelets (PLT) and fibrinogen (Fib) compared with those of the survival patients. The proportion of D-dimer and FDP abnormalities are higher than PT, APTT and Fib. Prolonged PT, low level of Fib and elevated total bilirubin (TBIL) on admission were considered as independent risk factors for prognosis (death). CONCLUSIONS Detection of PT, Fib and TBIL on admission is necessary, which might be benefit to early predicting prognosis. It is also important to pay attention to the dynamic coagulation disorders and hyperfibrinolysis during the early stage in the severe HFRS patients.
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Affiliation(s)
- Wen-Jing Chen
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Hong Du
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China.
| | - Hai-Feng Hu
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Jian-Qi Lian
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Hong Jiang
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Jing Li
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China
| | - Yan-Ping Chen
- Department of Infectious Diseases, the Second Affiliated People's Hospital of Yan 'an University, Yan'an, Shaanxi, China.
| | - Ying Zhang
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China.
| | - Ping-Zhong Wang
- Center for Infectious Diseases, the Second Affiliated Hospital of Air Force Medical University, 569 Xinsi Rd, Baqiao District, Xi'an, 710038, Shaanxi, China.
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Zhao HD, Sun JJ, Liu HL. Potential clinical biomarkers in monitoring the severity of Hantaan virus infection. Cytokine 2023; 170:156340. [PMID: 37607412 DOI: 10.1016/j.cyto.2023.156340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Hantavirus, which causes hemorrhagic fever with renal syndrome (HFRS) is almost prevalent worldwide. While Hantaan virus (HTNV) causes the most severe form of HFRS with typical clinical manifestations of thrombocytopenia, increased vascular permeability, and acute kidney injury. Although the knowledge of the pathogenesis of HFRS is still limited, immune dysfunction and pathological damage caused by disorders of immune regulation are proposed to play a vital role in the development of the disorder, and the endothelium is considered to be the primary target of hantaviruses. Here, we reviewed the production and function of multiple molecules, mainly focusing on their role in immune response, endothelium, vascular permeability regulation, and platelet and coagulation activation which are closely related to the pathogenesis of HTNV infection. meanwhile, the relationship between these molecules and characteristics of HTNV infection including the hospital duration, immune dysfunction, thrombocytopenia, leukocytosis, and acute kidney injury are also presented, to provide a novel insight into the potential role of these molecules as monitoring markers for HTNV infection.
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Affiliation(s)
- Han-Dong Zhao
- Central Laboratory of Virology, Shaanxi Provincial Hospital of Infectious Diseases, The Eighth Hospital Affiliated to Medical College of Xi'an Jiaotong University, Xi'an 710061, China
| | - Ju-Jun Sun
- Clinical Laboratory Center, XD Group Hospital, Xi'an 710077, China
| | - Hong-Li Liu
- Clinical Laboratory Center, Xi'an People's Hospital (Xi'an Fourth Hospital) Guang-Ren Hospital Affiliated to Xi'an Jiaotong University Health Science Center, Xi'an 710004, China.
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Noack D, Travar M, Mrdjen V, Voermans JJC, van de Vijver D, Molenkamp R, Koopmans MPG, Goeijenbier M, Rockx B. Serum Markers Associated with Disease Severity in a Bosnian Hemorrhagic Fever with Renal Syndrome Cohort. Viruses 2022; 14:v14071377. [PMID: 35891358 PMCID: PMC9316913 DOI: 10.3390/v14071377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/10/2022] [Accepted: 06/22/2022] [Indexed: 12/10/2022] Open
Abstract
Puumala orthohantavirus (PUUV) is endemic in Europe and can cause hemorrhagic fever with renal syndrome (nephropathia epidemica). Disease features include fever, thrombocytopenia, and acute kidney injury (AKI). This retrospective cohort study of forty PUUV patients aims to characterize associations of serum immunological, hemostatic or kidney injury markers to disease severity. While interleukin-18 (IL-18) was significantly increased in severely thrombocytopenic patients (<100 × 109 platelets/L) compared to patients with higher platelet counts, RANTES was significantly decreased in these patients. These data suggest that patients with significant thrombocytopenia might have experienced pronounced Th1 immune responses. When kidney dysfunction was used as the primary disease outcome, recently identified AKI biomarkers (Cystatin C, insulin-like growth factor-binding protein 7, Nephrin, and trefoil factor 3) were significantly upregulated in patients with severe PUUV infection, defined as the estimated glomerular filtration rate (eGFR) below 30 m/min/1.73 m2. The increased expression of these markers specifically indicates pathology in glomeruli and proximal tubuli. Furthermore, E-selectin was significantly higher while interferon gamma-induced protein 10 (IP-10) was significantly lower in PUUV patients with more severe kidney dysfunction compared to patients with higher eGFR-values. Increased E-selectin illustrates the central role of endothelial cell activation, whereas decreased IP-10 could indicate a less important role of this cytokine in the pathogenesis of kidney dysfunction.
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Affiliation(s)
- Danny Noack
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Maja Travar
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Visnja Mrdjen
- Department for Clinical Microbiology, University Clinical Center of Republika Srpska, 78000 Banja Luka, Bosnia and Herzegovina; (M.T.); (V.M.)
- Department for Microbiology and Immunology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, Republika Srpska, Bosnia and Herzegovina
| | - Jolanda J. C. Voermans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - David van de Vijver
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Richard Molenkamp
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marion P. G. Koopmans
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Department of Intensive Care, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Barry Rockx
- Department of Viroscience, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands; (D.N.); (J.J.C.V.); (D.v.d.V.); (R.M.); (M.P.G.K.); (M.G.)
- Correspondence:
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Severity Biomarkers in Puumala Hantavirus Infection. Viruses 2021; 14:v14010045. [PMID: 35062248 PMCID: PMC8778356 DOI: 10.3390/v14010045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 12/12/2022] Open
Abstract
Annually, over 10,000 cases of hemorrhagic fever with renal syndrome (HFRS) are diagnosed in Europe. Puumala hantavirus (PUUV) causes most of the European HFRS cases. PUUV causes usually a relatively mild disease, which is rarely fatal. However, the severity of the infection varies greatly, and factors affecting the severity are mostly unrevealed. Host genes are known to have an effect. The typical clinical features in PUUV infection include acute kidney injury, thrombocytopenia, and increased vascular permeability. The primary target of hantavirus is the endothelium of the vessels of different organs. Although PUUV does not cause direct cytopathology of the endothelial cells, remarkable changes in both the barrier function of the endothelium and the function of the infected endothelial cells occur. Host immune or inflammatory mechanisms are probably important in the development of the capillary leakage. Several immunoinflammatory biomarkers have been studied in the context of assessing the severity of HFRS caused by PUUV. Most of them are not used in clinical practice, but the increasing knowledge about the biomarkers has elucidated the pathogenesis of PUUV infection.
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Coagulopathy in Acute Puumala Hantavirus Infection. Viruses 2021; 13:v13081553. [PMID: 34452419 PMCID: PMC8402851 DOI: 10.3390/v13081553] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/27/2021] [Accepted: 08/02/2021] [Indexed: 12/26/2022] Open
Abstract
Puumala hantavirus (PUUV) causes a hemorrhagic fever with renal syndrome (HFRS), also called nephropathia epidemica (NE), which is mainly endemic in Europe and Russia. The clinical features include a low platelet count, altered coagulation, endothelial activation, and acute kidney injury (AKI). Multiple connections between coagulation pathways and inflammatory mediators, as well as complement and kallikrein–kinin systems, have been reported. The bleeding symptoms are usually mild. PUUV-infected patients also have an increased risk for disseminated intravascular coagulation (DIC) and thrombosis.
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Predictive value of pentraxin-3 on disease severity and mortality risk in patients with hemorrhagic fever with renal syndrome. BMC Infect Dis 2021; 21:445. [PMID: 34001041 PMCID: PMC8130374 DOI: 10.1186/s12879-021-06145-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/05/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Hemorrhagic fever with renal syndrome (HFRS) caused by Hantaan virus is characterized by systemic immunopathological injury. Pentraxin-3 is an acute-phase reactant involved in the processes of inflammation and infection. This study aimed to investigate the levels of plasma pentraxin-3 and evaluate its predictive value on disease severity and mortality risk in patients with HFRS. METHODS This was a prospective real-world observational study. The concentrations of plasma pentraxin-3 were measured by enzyme linked immunosorbent assay (ELISA) in 105 HFRS patients and 27 healthy controls. We analyzed the clinical relevance between pentraxin-3 and clinical subtyping, hospital stay and conventional laboratory parameters of HFRS patients. Considering the prognosis (death) as the primary endpoint, the levels of pentraxin-3 between survivors and non-survivors were compared, and its association with mortality was assessed by Kaplan-Meier survival analysis. The predictive potency of pentraxin-3 for mortality risk in HFRS patients was evaluated by receiver operating characteristic (ROC) curve analysis. RESULTS The levels of pentraxin-3 during the acute phase were increased with the aggravation of the disease, and showed the highest expression in critical-type patients (P < 0.05). Pentraxin-3 demonstrated significant correlations with conventional laboratory parameters (WBC, PLT, AST, ALB, APTT, Fib) and the length of hospital stay. Compared with the survivors, non-survivors showed higher levels of pentraxin-3 and worse expressions of conventional laboratory parameters during the acute phase. The Kaplan-Meier survival curves showed that high levels of pentraxin-3 during the acute phase were significantly associated with the death in HFRS patients. Pentraxin-3 demonstrated significant predictive value for the mortality risk of HFRS patients, with the area under ROC curve (AUC) of 0.753 (95%CI: 0.593 ~ 0.914, P = 0.003). CONCLUSIONS The detection of plasma pentraxin-3 might be beneficial to the evaluation of disease severity and to the prediction of mortality risk in HFRS patients.
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Pentraxin-3 is not related to disease severity in cirrhosis and hepatocellular carcinoma patients. Clin Exp Med 2020; 20:289-297. [PMID: 32078718 PMCID: PMC7181432 DOI: 10.1007/s10238-020-00617-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/15/2020] [Indexed: 12/19/2022]
Abstract
The acute-phase protein pentraxin-3 (PTX3) is a component of the innate immune system. Inflammation and tissue injury increased PTX3 in the injured liver, and accordingly, circulating PTX3 was induced in patients with chronic liver diseases. In the present study, PTX3 protein was determined in systemic, hepatic, and portal vein plasma of patients with liver cirrhosis to assess a possible association between hepatic PTX3 release and extent of liver injury. However, PTX3 levels were not related to disease severity. Of note, portal PTX3 levels were higher than concentrations in the hepatic vein. PTX3 in the hepatic and portal veins was negatively correlated with factor V, antithrombin 3, and prothrombin time. PTX3 did neither correlate with C-reactive protein nor galectin-3 or resistin, whereby the latter two proteins are associated with hepatic injury. PTX3 levels were not changed in cirrhosis patients with ascites or varices and did not correlate with the hepatic venous pressure gradient. Likewise, serum PTX3 was not correlated with histological steatosis, inflammation, or fibrosis stage in patients with hepatocellular carcinoma (HCC). Moreover, PTX3 was not associated with tumor node metastasis classification in HCC. Above all, PTX3 increased in hepatic, portal, and systemic blood immediately after transjugular intrahepatic portosystemic shunt (TIPS). Higher PTX3 in portal than hepatic vein plasma and further increase after TIPS suggests that the liver eliminates PTX3 from the circulation. In summary, PTX3 is not of diagnostic value in cirrhosis and HCC patients.
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Acute phase protein response to viral infection and vaccination. Arch Biochem Biophys 2019; 671:196-202. [PMID: 31323216 PMCID: PMC7094616 DOI: 10.1016/j.abb.2019.07.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/29/2019] [Accepted: 07/15/2019] [Indexed: 02/07/2023]
Abstract
Organisms respond in multiple ways to microbial infections. Pathogen invasion tipically triggers an inflammatory response where acute phase proteins (APP) have a key role. Pentraxins (PTX) are a family of highly conserved APP that play a part in the host defense against infection. The larger proteins of the family are simply named pentraxins, while c-reactive proteins (CRP) and serum amyloid proteins (SAA, SAP) are known as short pentraxins. Although high APP levels have been broadly associated with bacterial infections, there is a growing body of evidence revealing increased PTX, CRP and SAP expression upon viral infection. Furthermore, CRP, PTX and SAP have shown their potential as diagnostic markers and predictors of disease outcome. Likewise, the measurement of APP levels can be valuable to determine the efficacy of antiviral therapies and vaccines. From the practical point of view, the ability of APP to reduce viral infectivity has been observed in several virus-host models. This has prompted investigation efforts to assess the role of acute phase response proteins as immunoregulatory molecules and their potential as therapeutic reagents. This work aims to present an overview of the APP response to viral infections reviewing the current knowledge in the field.
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Mantula PS, Outinen TK, Jaatinen P, Hämäläinen M, Huhtala H, Pörsti IH, Vaheri A, Mustonen JT, Mäkelä SM. High plasma resistin associates with severe acute kidney injury in Puumala hantavirus infection. PLoS One 2018; 13:e0208017. [PMID: 30517161 PMCID: PMC6281250 DOI: 10.1371/journal.pone.0208017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022] Open
Abstract
Background Puumala hantavirus (PUUV) infected patients typically suffer from acute kidney injury (AKI). Adipokines have inflammation modulating functions in acute diseases including AKI. We examined plasma levels of three adipokines (resistin, leptin, and adiponectin) in acute PUUV infection and their associations with disease severity. Methods This study included 79 patients hospitalized due to acute PUUV infection. Plasma resistin, leptin, adiponectin, as well as IL-6 and CRP, were measured at the acute phase, recovery phase and one year after hospitalization. Results Plasma resistin levels were significantly higher in the acute phase compared to the recovery phase and one year after (median resistin 28 pg/mL (11–107) vs. 17 pg/mL (7–36) vs. 14 pg/mL (7–31), p<0.001). Maximum resistin concentration correlated with maximum plasma creatinine levels (r = 0.63; p<0.001). The higher the amount of albuminuria in the urine dipstick test (0–1+, 2+ or 3+) at admission, the higher the median of maximum resistin (24.7 pg/mL, 25.4 pg/mL and 39.6 pg/mL, respectively, p = 0.002). High resistin was also an independent risk factor for severe AKI (creatinine ≥353.6μmol/L) (OR 1.08, 95% CI 1.02–1.14). Neither plasma leptin nor adiponectin level had any correlation with creatinine concentration or the amount of albuminuria. Conclusions Plasma resistin independently associates with the severity of AKI in acute PUUV infection. The association of resistin with the amount of albuminuria suggests that the level of plasma resistin is not only influenced by renal clearance but could have some role in the pathogenesis of AKI during PUUV infection.
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Affiliation(s)
- Paula S. Mantula
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- * E-mail:
| | - Tuula K. Outinen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
| | - Pia Jaatinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Division of Intermal Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
| | - Mari Hämäläinen
- The Immunopharmacology Group, Faculty of Medicine and Life Sciences, University of Tampere and Tampere University Hospital, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Ilkka H. Pörsti
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Antti Vaheri
- Department of Virology, Medicum, University of Helsinki, Helsinki, Finland
| | - Jukka T. Mustonen
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Satu M. Mäkelä
- Tampere University Hospital, Department of Internal Medicine, Tampere, Finland
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
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Diminished coagulation capacity assessed by calibrated automated thrombography during acute Puumala hantavirus infection. Blood Coagul Fibrinolysis 2018; 29:55-60. [PMID: 28968301 DOI: 10.1097/mbc.0000000000000667] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
: Coagulation abnormalities are associated with Puumala-virus-induced hemorrhagic fever with renal syndrome (PUUV-HFRS). We evaluated the coagulation capacity of plasma during acute PUUV-HFRS by measuring thrombin generation using calibrated automated thrombography (CAT). The study cohort comprised 27 prospectively collected, consecutive, hospital-treated patients with acute PUUV infection. Blood samples were drawn in the acute phase and at the control visit approximately 5 weeks later. To evaluate thrombin generation, the lag time of initiation, endogenous thrombin potential (ETP), and peak and time to peak thrombin concentration were assessed by CAT in platelet poor plasma without corn trypsin inhibitor. Plasma levels of D-dimer, fibrinogen and prothrombin fragments (F1 + 2) were also evaluated. When the acute phase was compared with the control phase, ETP was decreased (median 1154 nmol/l/min, range 67-1785 vs. median 1385 nmol/l/min, range 670-1970; P < 0.001), while the lag time was prolonged (median 3.8 min, range 2.1-7.7 vs. median 2.9 min, range 2.0-4.1; P < 0.001). Low ETP correlated with low peak thrombin concentration (r = 0.833, P < 0.001). Prolonged time to peak associated with the lag time (r = 0.78, P < 0.001). ETP was associated with thrombocytopenia (r = 0.472, P = 0.015) and weakly with fibrinogen level (r = 0.386, P = 0.047). The measured CAT parameters did not associate with D-dimer and F1 + 2 levels. Decreased ETP together with low peak and prolonged lag time indicate decreased plasma potential for thrombin generation in vitro. Together with low platelet count and enhanced fibrinolysis, this further refers to altered blood coagulation and increased propensity toward bleeding in acute PUUV-HFRS.
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Khaiboullina SF, Morzunov SP, St Jeor SC, Rizvanov AA, Lombardi VC. Hantavirus Infection Suppresses Thrombospondin-1 Expression in Cultured Endothelial Cells in a Strain-Specific Manner. Front Microbiol 2016; 7:1077. [PMID: 27486439 PMCID: PMC4950404 DOI: 10.3389/fmicb.2016.01077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/27/2016] [Indexed: 11/13/2022] Open
Abstract
Hantavirus infection is associated with two frequently fatal diseases in humans: Hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS). The pathogenesis of hantavirus infection is complex and not fully understood; however, it is believed to involve virus-induced hyperinflammatory immune responses. Thrombospondin-1 (THBS1) is a large homotrimeric protein that plays a putative role in regulating blood homeostasis. Hyperresponsiveness to inflammatory stimuli has also been associated with defects in the THBS1 gene. Our data suggest that hantavirus infection of human umbilical cord vein endothelial cells (HUVEC) suppress the accumulation of THBS1 in the extracellular matrix. Additionally, this suppression is dependent on virus replication, implying a direct mechanism of action. Our data also imply that the pathogenic Andes and Hantaan strains inhibit THBS1 expression while the non-pathogenic Prospect Hill strain showed little inhibition. These observations suggest that a dysregulation of THBS1 may contribute to the pathogenesis of hantavirus infection.
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Affiliation(s)
- Svetlana F Khaiboullina
- Nevada Center for Biomedical ResearchReno, NV, USA; Department of Genetics, Institute of Fundamental Medicine and Biology, Kazan Federal UniversityKazan, Russia
| | - Sergey P Morzunov
- Nevada State Public Health Laboratory, University of Nevada, Reno School of Medicine Reno, NV, USA
| | - Stephen C St Jeor
- Department of Immunology and Microbiology, University of Nevada, Reno School of Medicine Reno, NV, USA
| | - Albert A Rizvanov
- Department of Genetics, Institute of Fundamental Medicine and Biology, Kazan Federal University Kazan, Russia
| | - Vincent C Lombardi
- Nevada Center for Biomedical ResearchReno, NV, USA; Department of Biochemistry and Molecular Biology, University of NevadaReno, NV, USA
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Goeijenbier M, Meijers JCM, Anfasa F, Roose JM, van de Weg CAM, Bakhtiari K, Henttonen H, Vaheri A, Osterhaus ADME, van Gorp ECM, Martina BEE. Effect of Puumala hantavirus infection on human umbilical vein endothelial cell hemostatic function: platelet interactions, increased tissue factor expression and fibrinolysis regulator release. Front Microbiol 2015; 6:220. [PMID: 25852676 PMCID: PMC4371750 DOI: 10.3389/fmicb.2015.00220] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 03/05/2015] [Indexed: 12/02/2022] Open
Abstract
Puumala virus (PUUV) infection causes over 5000 cases of hemorrhagic fever in Europe annually and can influence the hemostatic balance extensively. Infection might lead to hemorrhage, while a recent study showed an increased risk of myocardial infarction during or shortly after PUUV infection. The mechanism by which this hantavirus influences the coagulation system remains unknown. Therefore we aimed to elucidate mechanisms explaining alterations seen in primary and secondary hemostasis during PUUV infection. By using low passage PUUV isolates to infect primary human umbilical vein endothelial cells (HUVECs) we were able to show alterations in the regulation of primary- and secondary hemostasis and in the release of fibrinolysis regulators. Our main finding was an activation of secondary hemostasis due to increased tissue factor (TF) expression leading to increased thrombin generation in a functional assay. Furthermore, we showed that during infection platelets adhered to HUVEC and subsequently specifically to PUUV virus particles. Infection of HUVEC with PUUV did not result in increased von Willebrand factor while they produced more plasminogen activator inhibitor type-1 (PAI-1) compared to controls. The PAI-1 produced in this model formed complexes with vitronectin. This is the first report that reveals a potential mechanism behind the pro-coagulant changes in PUUV patients, which could be the result of increased thrombin generation due to an increased TF expression on endothelial cells during infection. Furthermore, we provide insight into the contribution of endothelial cell responses regarding hemostasis in PUUV pathogenesis.
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Affiliation(s)
| | - Joost C M Meijers
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands ; Department of Plasma Proteins, Sanquin Research, Amsterdam Netherlands
| | - Fatih Anfasa
- Department of Viroscience, Erasmus MC, Rotterdam Netherlands ; Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia Jakarta, Indonesia
| | - Jeroen M Roose
- Department of Viroscience, Erasmus MC, Rotterdam Netherlands ; Artemis One Health Institute, Utrecht Netherlands
| | | | - Kamran Bakhtiari
- Department of Experimental Vascular Medicine, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands ; Department of Plasma Proteins, Sanquin Research, Amsterdam Netherlands
| | | | - Antti Vaheri
- Department of Virology, Haartman Institute, University Of Helsinki Helsinki, Finland
| | - Albert D M E Osterhaus
- Department of Viroscience, Erasmus MC, Rotterdam Netherlands ; Artemis One Health Institute, Utrecht Netherlands
| | | | - Byron E E Martina
- Department of Viroscience, Erasmus MC, Rotterdam Netherlands ; Artemis One Health Institute, Utrecht Netherlands
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Hepojoki J, Vaheri A, Strandin T. The fundamental role of endothelial cells in hantavirus pathogenesis. Front Microbiol 2014; 5:727. [PMID: 25566236 PMCID: PMC4273638 DOI: 10.3389/fmicb.2014.00727] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/03/2014] [Indexed: 01/17/2023] Open
Abstract
Hantavirus, a genus of rodent- and insectivore-borne viruses in the family Bunyaviridae, is a group of emerging zoonotic pathogens. Hantaviruses cause hemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome in man, often with severe consequences. Vascular leakage is evident in severe hantavirus infections, and increased permeability contributes to the pathogenesis. This review summarizes the current knowledge on hantavirus interactions with hematopoietic and endothelial cells, and their effects on the increased vascular permeability.
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Affiliation(s)
- Jussi Hepojoki
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
| | - Antti Vaheri
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
| | - Tomas Strandin
- Department of Virology, Haartman Institute, University of Helsinki Helsinki, Finland
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